下颌骨髁突囊内骨折不同治疗方法的冠状CT评价

Evaluation of the treatment for intracapsular condyle fracture of the mandible by coronal CT

目的:通过冠状CT评价下颌骨髁突囊内骨折不同治疗方法的影像学效果。方法:对2002-2008年在上海交通大学医学院附属第九人民医院口腔颌面外科关节组就诊经冠状CT诊断为下颌骨髁突囊内骨折的病例183例(242侧),进行不同治疗方法(非手术和手术治疗)的影像学评价。结果:非手术治疗组94例127侧髁突中,48例64侧有3个月以上的随访CT,其中发生错位愈合或改建41例52侧,占81.2%;继发关节强直7例12侧,占非手术治疗的9.4%。手术治疗组89例115侧髁突的术后CT显示,81.7%的髁突达到解剖复位,13.9%接近解剖复位,4.3%复位欠佳。35例48侧有术后3个月以上的随访,其中髁突骨折愈合良好的32例44侧,占91.7%;钛板位置过高2例3侧,占6.2%;髁突骨质吸收、取出钛板1例1侧,占2.1%。结论:冠状CT对髁突囊内骨折的诊断和治疗效果评价有重要作用。非手术治疗的髁突囊内骨折大部分发生错位愈合或改建,少数形成关节强直;手术治疗可以恢复髁突的解剖形态,有利于关节功能的恢复。

PURPOSE： To evaluate the results of two different treatment methods in intracapsular condyle fracture （ICF） of the mandible by coronal CT. METHODS： One hundred and eighty-three ICF cases with 242 condyles treated in the division of TMJ in Shanghai Ninth People＇s Hospital from 2002 to 2008 were evaluated by coronal CT before and after non-surgical and surgical treatment. RESULTS： There were ninety-four cases with 127 condyles in the non-surgical treatment group. Forty-eight cases with 64 condyles had more than 3 months CT follow-up. Among them, 41 eases with 52 condyles healed or remodeled, which accounted for 81.2% ;seven cases with 12 condyles developed TMJ ankylosis, which accounted for 9.4% in the non-surgleal treatment group. There were eighty-nine cases with 115 condyles in the surgical treatment group. Post-operative CT showed anatomic reduction in 81.7% of the condyles, near anatomic reduction in 13.9% and not anatomic reduction in 4.3% of the condyles. Thirty-five eases had more than 3 months CT follow ups. Among them. 32 cases with 44 condyles showed good healing, which accounted for 91.7%. Two eases with 3 condyles had the plates located too high, which accounted for 6.2%. One ease with 1 condyle had plate removed because of resorption, which accounted for 2.1%. CONCLUSIONS： Coronal CT has a very important role in the diagnosis and treatment evaluation of ICF. With non-surgical treatment, most of the condyles healed with deformity or remodeling, few developed TMJ ankylosis. By surgical treatment, the condyles can be reduced anatomically which is good for the restoration of TMJ functional activities.